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Background Chronic kidney disease (CKD) is a common medical condition that is increasing in prevalence. Existing published evidence has revealed through regression analyses that several clinical characteristics are associated with mortality in CKD patients. However, the predictive accuracies of these risk factors for mortality have not been clearly demonstrated. Aim To demonstrate the accuracy of mortality predictive factors in CKD patients by utilizing the area under the receiver operating characteristic (ROC) curve (AUC) analysis. Methods We searched Ovid MEDLINE, EMBASE, and the Cochrane Library for eligible articles through January 2021. Studies were included based on the following criteria: (1) Study nature was observational or conference abstract; (2) Study populations involved patients with non-transplant CKD at any CKD stage severity; and (3) Predictive factors for mortality were presented with AUC analysis and its associated 95% confidence interval (CI). AUC of 0.70-0.79 is considered acceptable, 0.80-0.89 is considered excellent, and more than 0.90 is considered outstanding. Results Of 1759 citations, a total of 18 studies (n = 14579) were included in this systematic review. Eight hundred thirty two patients had non-dialysis CKD, and 13747 patients had dialysis-dependent CKD (2160 patients on hemodialysis, 370 patients on peritoneal dialysis, and 11217 patients on non-differentiated dialysis modality). Of 24 mortality predictive factors, none were deemed outstanding for mortality prediction. A total of seven predictive factors [N-terminal pro-brain natriuretic peptide (NT-proBNP), BNP, soluble urokinase plasminogen activator receptor (suPAR), augmentation index, left atrial reservoir strain, C-reactive protein, and systolic pulmonary artery pressure] were identified as excellent. Seventeen predictive factors were in the acceptable range, which we classified into the following subgroups: predictors for the non-dialysis population, echocardiographic factors, comorbidities, and miscellaneous. Conclusion Several factors were found to predict mortality in CKD patients. Echocardiography is an important tool for mortality prognostication in CKD patients by evaluating left atrial reservoir strain, systolic pulmonary artery pressure, diastolic function, and left ventricular mass index.

Various studies have suggested the possible cardiovascular (CV) protective effects of the pneumococcal vaccine (PV). Therefore, we conducted a meta-analysis to assess the association between recipients of PV with mortality and CV outcomes among patients with and without established cardiovascular disease. We performed a systematic literature search in PubMed, Embase, and Scopus for studies evaluating the effect of PV on mortality and CV outcomes. A total of 15 studies with 347,444 patients were included in the meta-analysis: 111,784 patients received PV (32%) and 235,660 patients were in the unvaccinated group (68%). Recipients of PV were associated with decreased all-cause mortality (HR, 0.76 (95% CI: 0.66 to 0.87), p < 0.001). PV was associated with a decrease in the incidence of myocardial infarction (MI) (HR, 0.73 (95% CI: 0.56–0.96), p = 0.02), without significant reduction in CV mortality (HR, 0.87 (95% CI: 0.72–1.07), p = 0.18) and stroke (HR, 1.01 (95% CI: 0.93–1.10), p = 0.82). Our study found PV was associated with decreased risk of all-cause mortality and MI. Future RCTs will be necessary to confirm benefits associated with receipt of PV.

There is an increasing COVID-19 population with concurrent STEMI. SARS-CoV-2 poses a significant risk of hypercoagulable and/or prothrombotic events due to the disturbance in hemostasis by affecting all three components of the Virchow's triad. These abnormalities in hemostasis are an increased risk factor for cardiovascular events, including acute thrombotic occlusion of coronary arteries leading to myocardial infarction.The objective of this study is to collate the prognosis, symptomatology and clinical findings of COVID-19 adverse events causing STEMI.Databases were queried with various keyword combinations to find applicable articles. Cardiovascular risk factors, symptomatology, mortality and rates of PCI were analyzed using random-effect model.15 studies with a total of 379 patients were included in the final analysis. Mean age of patients was 62.82 ± 36.01, with a male predominance (72%, n = 274). Hypertension, dyslipidemia and diabetes mellitus were the most common cardiovascular risk factors among these patients, with a pooled proportion of 72%, 59% and 40% respectively. Dyspnea (61%, n = 131) was the most frequent presenting symptom, followed by chest pain (60%, n = 101) and fever (56%, n = 104). 62% of the patients had obstructive CAD during coronary angiography. The primary reperfusion method used in the majority of cases was percutaneous coronary intervention (64%, n = 124). Mortality, which is the primary outcome in our study, was relatively high, with a rate of 34% across studies.Our findings show that most cases have been found in males, while the most common risk factors were Hypertension and Diabetes Mellitus. In most COVID-19 cases with ST-segment myocardial infarction, most hospitalized patients underwent primary percutaneous coronary intervention instead of fibrinolysis. The in-hospital mortality was significantly higher, making this report significant. As the sample size and reported study are considerably less, it warrants a further large-scale investigation to generalize it.

Background: The use of maximum tolerated doses of guideline directed medical therapy (GDMT) for patient with heart failure with reduced ejection fraction (HFrEF) has been suboptimal in routine clinical practice. In particular, the rate of adoption of the angiotensin receptor blocker-neprilysin inhibitor (ARNI) has lagged. In this study, we aim to evaluate the use of optimal GDMT and the effect of ARNI on heart failure related re-admission (HFRR) in a real life setting from a single center community hospital. Method: Retrospective chart review was conducted in patients who were admitted to our hospital system for HFrEF between December 2019-January 2021. Data was collected for patient demographics, comorbidities, admission and discharge medications, length of stay and rate of 30-day HFRR. Results: 357 patients were included in the analysis. 92.7% were discharged on beta blockers, 50% were discharged on ACE-I/ARB, 6.4% were discharged on ARNI and 47.75% were discharged on MRAs. The target doses of each were only achieved in 7.3%, 27%, 100% and stage 3, and lower BNP levels than those discharged on ACE-I/ARB. HFRR was lower in patient discharged on ARNI vs ACE-I/ARB (4.17% vs 16%), although this was not statistically significant due to low sample volume (p = 0.20). Conclusion: Our study shows that the rate of adoption of GDMT, especially ARNI, in hospitalized HFrEF patients in clinical practice lags significantly behind from that reported in clinical trials. Although there was no statistical significance achieved in comparison due to small sample size, we see a trend of decreased heart failure readmission in patients discharged on ARNI. The wide gap of adoption of GDMT in the real world remains a challenge, and adversely impacts patient outcomes.

Introduction: Hybrid-Convergent procedure(HCP) has been recently approved for treatment of persistent atrial fibrillation(AF). This was studied as a same day procedure which posed significant scheduling challenges with regards to procedure space and personnel. Staging the procedure was more convenient in smaller and busy Community Hospitals like ours. We report our experience with Staged HCP. Methods: We retrospectively analyzed all patients who underwent HCP at our Hospital from January 1,2017 to December 31,2020. Same day HCP were excluded. Outcomes at 6 month and 1 year follow up after the procedure were analyzed. Results: A total of 29 patients with persistent AF underwent Staged HCP. The mean age was 62.3 years with 75.86% being men. Periprocedural and 30 day mortality was 0%. The mean time between epicardial ablation and endocardial ablation was 46.15 days (SD :17.5 days, interquartile range 6-78). Freedom from AF (normal sinus rhythm on electrocardiograms and/or 24 hour monitoring) was seen in 77.78% and 88% patients at 6 months and 1 year respectively. Success of procedure (freedom from AF with maintenance as before procedure, decrease in dose of or complete cessation of Class I/III anti-arrhythmic drug) was seen in 70.4% and 76% at 6 months and 1 year respectively. The de-escalation in treatment (complete cessation or dose reduction of Class I/III anti-arrhythmic drug) at 6 month and 1 year follow up was seen in 57.14% and in 54.55% patients respectively. Conclusions: Staged HCP can be done safely with excellent outcomes on par with results seen in the CONVERGE Clinical Trial

Kugel’s artery is defined as a rare anatomical variant of the coronary artery vascular bed consisting of an anastomotic connection between branches of the right coronary artery (RCA) and/or left circumflex artery (LCX). Kugel’s artery has been reported to have an incidence of 6% in the general population. The presence of this anastomotic communication may play a pathophysiological role in a patient with a right dominant coronary circulation and an underlying coronary artery disease (CAD) affecting the right coronary system. Understanding the existence and significance of Kugel’s artery and the anastomotic network cannot be overemphasized. The presence of an anomalous vascular connection bypassing an area of epicardial vessel occlusion may be a lifesaving pathophysiological finding that maintains myocardial perfusion and viability. Herein, we present a case with multivessel occlusion myocardial infarction found to have anomalous vascular anastomosis between the proximal RCA and distal segment of the same artery.

The incidence of venous thromboembolism (VTE) in ANCA-associated vasculitis patients varies in different populations. Moreover, the risk factors for VTE in these patients are poorly described due to the small number of events. Ovid MEDLINE, EMBASE, and the Cochrane Library were searched for eligible articles. The inclusion criteria included observational studies that enrolled patients age ≥ 18 years diagnosed with ANCA-associated vasculitis. The incidence of VTE is the outcome of interest. Of 1362 citations, a total of 21 studies (n = 4422) dated from 2006 to 2019 were included in the systematic review. The mean age was 54.2 ± 4.0 years. Most were male (52.0%) and Caucasian (80.9%). With a mean follow-up duration of 5.2 ± 2.8 years, the pooled incidence of VTE in ANCA-associated vasculitis patients was 12.4% (95% CI, 8.8-17.2). Of these, 63.4% (95% CI, 57.3-69.1) had deep vein thrombosis and 26.3% (95% CI, 17.6-37.4) had pulmonary embolism. Recurrent VTE occurred in 10.0% (95% CI, 5.2-18.6). From the metaregression adjusted for age, sex, and ethnicity; positive MPO-ANCA, increasing Birmingham Vasculitis Activity Score at time of vasculitis diagnosis, and presence of renal involvement were positively associated with increased VTE events. Positive PR3-ANCA profile was inversely associated with increased VTE events. Increasing follow-up duration was not associated with increased VTE events. VTE in ANCA-associated vasculitis is common. Positive MPO-ANCA, increasing vasculitis activity, and presence of renal involvement were significant risk factors for VTE while positive PR3-ANCA was inversely associated with increased VTE. Key Points • Venous thromboembolism (VTE) is common in ANCA-associated vasculitis with a pooled incidence of 12.4% • Deep vein thrombosis accounts for two-third of total VTE cases • Positive MPO-ANCA profile, higher disease activity at ANCA-associated vasculitis diagnosis, and renal involvement are risk factors for VTE • Positive PR3-ANCA profile is protective factor for VTE.